Cut Your Bariatric Surgery Risk

Got diabetes and a BMI above 35? Bariatric surgery to help you manage your diabetes could be an excellent idea. But be aware that going to the closest hospital for the procedure -- simply because it’s near your home -- might not be the safest bet.

Accredited vs. non-accredited surgery facilities

A recent systematic review of 13 medical studies including more than a million people found that weight-loss operations in accredited bariatric surgical facilities in the U.S. are much safer than in facilities that aren’t accredited. In fact, "patients who have weight-loss operations at non-accredited bariatric surgical facilities in the United States are up to 1.4 times likelier to experience serious complications and more than twice as likely to die after the operation compared with patients who undergo these procedures at accredited bariatric surgical centers," according to a July 12, 2016, press release from the American College of Surgeons announcing the review's findings. This review study is the first comprehensive look at the best available evidence comparing bariatric surgical results in accredited and non-accredited American centers.

The study, “Bariatric Surgery Outcomes in U.S. Accredited vs. Non-accredited Centers: A Systematic Review,” will be published in full in a forthcoming issue of the peer-reviewed Journal of the American College of Surgeons. Meanwhile, a representative of the college sent me the full text of the study.

Patients often choose where they get bariatric surgery on the basis of how far the facility is from their homes, says the study’s corresponding author, John Morton, MD. He is the chief of bariatric and minimally invasive surgery at Stanford University’s School of Medicine and the immediate past-president of the American Society for Metabolic and Bariatric Surgery.

You can see a 7-minute video featuring Dr. Morton and his work here. I found the before-and-after pictures of some of the people who underwent bariatric surgery to be quite moving.

“It's worth it for patients to drive a few minutes longer to an accredited center,” Dr. Morton says. “The drive is typically short, with more than 700 accredited centers nationwide. Accredited bariatric surgical centers provide not only safer care, but also less expensive care.”

The greater safety at accredited facilities is especially important for people with diabetes.

“People with diabetes do have higher risks of complications following bariatric and all surgeries,” Dr. Morton wrote me. “Some surgical specialties, like orthopedics, employ bariatric surgery prior to joint replacement to reduce risks of obesity and diabetes.”

Laparoscopic bariatric surgery, whether Roux-en-Y gastric bypass or gastric banding, is safer than traditional “open” surgical procedures, he says. Still, “even though we use little incisions, it's still a big operation,” Dr. Morton says. “Accreditation indicates that a bariatric surgical center has the resources and experience in place to take care of any complications that may occur.”

Complications and mortality rates

In a 2012 study for which he was lead author, Dr. Morton reported the 30-day rates of serious complications and mortality. Gastric banding had the fewest serious complications: one-quarter of one percent. This was followed by sleeve gastrectomies, at a bit less than one percent, and gastric bypass, at 1.25 percent.

Gastric banding was also the best for its 30-day mortality rate of .03 percent. Next was sleeve gastrectomy, 0.08 percent, and gastric bypass, 0.14 percent. Each of these rates is better than those for gallbladder or hip replacement surgery, for example.

Bariatric surgery is an elective operation, one that you choose to have when you are ready. This gives you much more of a choice in picking the facility. Be sure to stack the odds in your favor.

David Mendosa is a journalist who learned in 1994 that he has Type 2 diabetes, which he now writes about exclusively. He has written thousands of diabetes articles, two books about it, createdone of the first diabetes websites, and publishes the monthly newsletter, “Diabetes Update.” His very low-carbohydrate diet, current A1C level of 5.5, and BMI of 19.8 keeps his diabetes inremissionwithout any drugs.